Getting ahead of migraine

Exploring migraine experiences and approaches to treatment

Writer Mary-Louise Leidl explores the topic of women and migraines, including migraine triggers, effects on health and the complementary medical treatments available. She interviews two women working at CWHN about their experiences and three healthcare practitioners about their approaches to managing migraines.

Jane Shulman, a Montreal-based journalist and webinar producer at CWHN, was only 11 years old when she experienced her first migraine: “It was terrifying. My mother and I ended up in the emergency room because we didn’t know what was wrong ... I was in so much pain all of a sudden and there was no reason for it.” Fortunately, the doctor on call was able to diagnose the sudden onset of symptoms as migraine, an affliction that plagues more than 2.7 million Canadians according to a Statistics Canada 2010/2011 Canadian Community Health Survey. The diagnosis, however, has not made it any easier for Shulman, and others like her, to manage this debilitating condition that is three times more common in women than in men.

More than a headache

A migraine is not a bad headache; it’s much worse. Migraine’s main symptoms, apart from the headache pain, include nausea, vomiting, as well as extreme sensitivity to light and/or noise, all of which are aggravated by physical activity. Throbbing pain is mostly confined to one side of the head, and can be severe enough to force a person to seek a dark quiet place to rest for as long as the migraine lasts, which can be anywhere from four hours to three days and more.

Migraine is classified into two main categories: migraine with aura and migraine without. Migraine with aura precedes the onset of the actual migraine, with temporary symptoms ranging from tingling or numbness in the face or hands to visual affects such as flashing or floating lights, jagged lines, blurred vision or peripheral blindness. Other short-term symptoms can include a distorted sense of taste, touch or smell. Migraine can even result in mental disorientation, affecting cognitive function and speech.

Getting to know the triggers

To those prone to allergic-type reactions, migraines are often triggered by specific substances found in food and drink. The main culprits are alcohol, especially red wine, caffeine, the tyramines found in various nuts, fermented foods and aged cheeses, phenyl ethylamine in cocoa, nitrites and nitrates in processed meats, monosodium glutamate (MSG), aspartame, and sulfites used in dried fruits, but there are many others.

Triggers are numerous and vary greatly from one individual to the next. Ellen Reynolds, editor of CWHN’s Network magazine, has experienced migraine, headache and visual disturbances since the age of about seven. She underwent various tests to ascertain the cause, but it was another three years before she understood, if not the cause, at least some of the triggers: “I first made the connection after eating a cake made from a mix that included artificial flavours and colouring. It was a particular lemon cake mix and I recognize the chemical smell to this day.” She felt a sudden flush of heat and experienced visual disturbances, migraine and vomiting. Over the years she has identified other triggers, including nitrites, MSG, perfume, dark chocolate and even the flavouring in dental fluoride preparations.

For Shulman, the main triggers are environmental, including fluorescent and halogen lighting, and the chemical smells emitted from cleaners and perfumes. In susceptible persons, certain sounds and even motion can set the stage for migraine. Too little sleep, passive smoking and sunlight can also be triggers. Heredity may play a part, but for women, perhaps the greatest underlying factors triggering migraine are fluctuating hormones associated with the menstrual cycle and acute periods of stress.

In 1998/99, Statistics Canada’s National Population Health Survey reported that 7.9 per cent of Canadians over the age of 12 had been diagnosed with migraine in that period: 11.7 per cent were female compared to 3.8 per cent male (up until the age girls begin their menses, migraine is slightly more common in boys). Migraine, however, was highest among those aged 25 to 39. In this age group almost 4 times as many women were diagnosed with migraine compared to men: 15.5 per cent and four per cent respectively.

More recent data from the Canadian Community Health Survey (CCHS) of 2010/11 reports that the percentage of Canadians diagnosed with migraines has remained the same (7.9 per cent); however, the more recent survey does not include gender-specific data.